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Online Claiming Program Disclaimer – Illinois

Online Claiming Program Disclaimer – Illinois

The online claiming program disclaimer is a contract/agreement between you and the Association for Child Development (ACD) indicating your responsibilities as an online claiming provider.  No online claim menus will be processed until a signed disclaimer is received at ACD.  This form is valid for the state of Illinois.   Please click on the “Download as PDF” link to download the form.

Download as PDF